This application seeks support to conduct a longitudinal follow-up to adulthood of infants who were extremely low birthweight (ELBW, <1000g) and a comparison group of matched term controls. These children (1977-1982 births) have already been followed on a broad range of measures, from multiple perspectives, from infancy to adolescence. These studies have created an extensive data base from assessments conducted at birth, 3,5,8 and 12 to 16 years of age on components of child health, cognition and behavior, school difficulties and utilization of health care and educational resources. In the proposed study, the assessments will be performed between 2001 and 2003 when the subjects will be 20 to 24 years of age. The study will focus on 2 major areas of transition from adolescence to adulthood: 1) worker/student role and 2) peer and partner relationships (social functioning). The study will examine the developmental and health trajectories over time (from infancy to adulthood) on both cohorts in several domains; general health, functional limitations, social, emotional, vocational, independent adult role functioning, peer and partner relationships, personal feelings of satisfaction, and assessment of health-related quality of life (HRQL). We will also explore the impact of biological and early health determinants, family characteristics, and child health and environmental factors on adult functioning across time. Lastly, we will compare the economic productivity and burden of health care between ELBW and control subjects at adulthood. Significance: These sociological, adaptive and health-related quality of life perspectives of premature children who have reach adulthood are virtually unknown. Such information is necessary for pediatricians and social workers to assist parents in facilitating the transition to independent adult living, and for health- care planners to ensure that adequate resources and facilities are available for those with special needs. A fuller understanding of the size of the economic burdens associated with ELBW is relevant for both social policies and for parents to make informed choices regarding neonatal intervention for infants at the margins of viability.